Though not yet available in the U.S., ultrasound ablation is part of the prostate cancer treatment spectrum in other countries. MRI-guided treatment is currently in clinical trials in the U.S. for low-risk prostate cancer, though it is yet to be approved by the Federal Drug Administration (FDA). Based on preliminary results, researchers believe the procedure could yield fewer side effects than other prostate cancer treatment options, such as robotic prostate surgery.
New York robotic prostate surgeon, David B. Samadi, MD, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, is cautiously optimistic. "MRI visualization is very good, but without the firsthand, tactile information afforded by surgery, disease assessment and complete elimination are more challenging."
During ablation, prostate cancer cells are destroyed using targeted ultrasound energy and are later naturally expelled by the body. Similar to High Intensity Focused Ultrasound (HIFU), also not FDA-approved in the U.S., treatment location and amount are determined through the use of MRI data gathered before and during the procedure. While less invasive than radical prostatectomy, ablation treatment is based solely on what can be seen through the MRI.
"Surgical removal of the cancerous prostate has numerous advantages. It gives me the opportunity to assess the prostate, seminal vesicles, and lymph nodes for signs of cancer or abnormality," said Dr. Samadi who uses a custom prostate removal procedure called SMART Surgery (Samadi Modified Advanced Robotic Technique).
In addition to removing the cancerous prostate from the body, surgery also affords post-surgery tumor analysis. "After surgery, my patients have the assurance of laboratory tumor testing, the most thorough way to accurately stage the disease and evaluate surgical margins. It is not unusual for lab testing to determine that a man's prostate cancer is more aggressive than pretreatment tests indicated," Dr. Samadi said.
While researchers in the U.S. clinical trial have not yet published the observed side effects of ultrasound ablation, comparable HIFU therapy can result in erectile dysfunction, ejaculation problems, urinary incontinence, and rectal wall injury.
As with all prostate cancer treatments, men are encouraged to gather multiple expert opinions and carefully weigh the pros and cons of each treatment with their disease status, age, and lifestyle.